Giacomo,
Thanks for offering a medically informed addition to the conversation.

No wonder there is no intelligent political discussion in this country, everyone on both sides just trys to make a point despite what the facts might really be.

What are the FACTS of this case - anyone care?

That said, if he's at such high risk that fixing the fracture isn't an option, particularly if he keeps smoking, then they could at least offer him an amputation, which would be likely to solve the pain issue and leave him ambulatory.

The case recounted here seems that it might possibly be an instance where a need-based system has failed to make a proper assessment. I am sure that there are avenues available for appeal - as a last resort one could appeal to ones legislator, given that the system is public, or the media

I have noticed a few people responding to incidents like this with the idea that there must be some reasonable government authority who will help fix the mistake the other government bureaucracy made.

Unfortunately this is not a reasonable assumption as the following link illustrates.

Why I am a Small l Libertarian

My wife and I wanted to put an addition on our house here in the City of Los Angeles. Our general contractor told us that the first thing we had to do was get up-to-date zoning and property information from the Building Pemits Department. He recommended that we hire a "fixer" who was used to dealing with the bureaucracy. That was 2 months ago.

Today, we were informed by the City zoning department that they could not give us the necessary zoning information ... because, according to zoning records, our house does not exist! On top of which, the zoning folks also had no record of the street on which we live.

The rest of the gory details are presented at the link, it is well worth reading.

I'm supposing the guy has already paid for his health coverage through his taxes. If the UK gov't is going to start segregating health care for smokers, will then they start taxing smokers less than non-smokers?

American HMOs would never treat smokers differently would they? The wouldn't dream of charging smokers more for care than non-smokers would they?
You can get nailed with higher costs before or with less coverage later, but either way in either system you have to pay for this lifestyle choice when it comes to health care.
It seems that cigarette taxes could be given to the health care system to defray or even pay the costs of tobacco on the system.

Is American health care more productive?

The proper way to measure the performance of health care is to measure the difference it makes in the quality of life of people who come for help...What we need to know is whether the higher level of spending means the United States is much less productive in health care than other countries.

In an attempt to test the limits of knowledge here, we studied the treatment of four diseases -- diabetes, cholelithiasis (gallstones), breast cancer, and lung cancer -- in three countries: Germany, the United Kingdom, and the United States. These three countries were the only countries for which comparable data existed for these diseases, either nationwide or for large regions.

The United States is more productive in all these diseases except for diabetes in the United Kingdom. [emphasis added] The reasons for this result can be traced directly to the huge differences in the way the health care sector is organized and governed across these three countries.

You need to look at the entire system and how it effects the entire population. Every study I have seen that does this ranks the care received as better in universal care countries and their costs less. Can you point to any studies by any non-partisan group that refutes these results?

Sure, check out this link

The "crippled and broken " US health care system comes through again

The researchers, whose report is published in the journal Annals of Oncology, found that Austria, France, Switzerland and the US were leaders in using new cancer drugs.

The greatest differences in the uptake of drugs were noted for the new colorectal and lung cancer drugs.

The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average.

Having had a massively broken ankle that required pins and plates, I find this story horrific. I cannot imagine having to have a doctor, someone there to heal me, tell me that.

So you reject the notion of universal health care? Funny after all your defenses of it.

Acknowledging that resources are not unlimited does not equal rejection of universal care as you well know despite the snark.

And who makes such a determination?

Ideally a doctor or doctors with the patient. Often though in the US the decision is made by a bureaucrat in an insurance company office dozens or hundreds of miles away. For the average American that has health insurance coverage is rationed by their HMO.

I am sure you would concede the existence of many anectdotes of private insurance companies denying coverage for things that you and I would judge necessary. What is the recourse then?
Moving of the goal posts duly

No, clear parallel.

By law hospitals are required to render care irrespective of ability to pay.

You leave out one very important word. By law hospitals are required to render emergency care irrespective of ability to pay and then their requirement is to stabilize the patient. Some doctors and hospitals do offer charity care, but they are not required to provide non-emergency care to those unable to pay.
I believe that EMTALA is the legislation that covers this. Maybe you should read it.

Insurance doesn't work that you need an operation so you go sign up. No insurance company could ever be profitable.

So government insurance won't do it equals bad, but private insurer won't do it equals understandable because they need to make a profit?

But they will do it, because that is the law.

It is not emergency care so no.

Yes you are wrong. Going to the ER will get it done. You can get just about anything via the ER if you wait long enough and complain vociferously enough.

If you complain loudly enough may recieve what is referred to as charity care or uncompensated care (bad debt) but care is not legally mandated unless it is an emergency.

This is one reason why health care in the U.S. is so expensive. To the extent that a government provided program reduces this kind of usage of ERs it will save money. But the increased demand due to increasing the number of people who have easier access to health care will raise costs.

The indigent waiting until a medical situation becomes an emergency and only then seeking care at among the most expensive outlets (ERs) is one of the myriad reasons for the high price of American medical care. Universal care would allow care before the situation became an emergency when treatment is cheaper not only because the venue is different but because the situation is cheaper and easier to treat. Ex/ A child with an ear infection is far easier and cheaper to treat in the early stages than when it has progressed to the point that it is an emergency (pus or blood leaking from the ear, possible permanent hearing damage, etc.).

If he will not, what does that say about his priorities?

What?!?!?! I'm shocked. You'd better be careful your good standing as a collectivist could be called into question here.

No real response, I'm shocked! He refuses to quit smoking for the four weeks prior to an operation to save him what he terms daily agony. He obviously wants the cigs more than he wants the pain to stop. He doesn't even have to quit forever. He can pick up a pack and return to the habit that has created the "chest problem" that prevents him from working on his way home from the hospital.

Denying coverage is one thing, denying care is another matter entirely.

The man in the case you described was denied coverage that resulted in his not being able to afford care.

First of all, in the real world the difference is not as clear as you may think. If the procedure would cost something on the order of a year of your salary (common for us peasants), then a denial of coverage = a denial of care.

"By law hospitals are required to render care irrespective of ability to pay."

Thats malarky - in the context of this discussion. Hospitals are NOT required to do an expensive, possibly dangerous, elective surgery of the type that you describe in this post.

"Insurance doesn't work that you need an operation so you go sign up. No insurance company could ever be profitable."

I guess you are having a bit of a slow day, Steve. Yes, that is the point. If your insurance company wont pay for your surgery, then the private marketplace does not offer any recourse.

No one is so dumb as to not realize that limited resources need to be rationed. The question is - for health care - what is the rationing criterion, need or wealth?

So you reject the notion of universal health care? Funny after all your defenses of it.

The case recounted here seems that it might possibly be an instance where a need-based system has failed to make a proper assessment.

And who makes such a determination? The electorate might decide that this is just fine...if enough of the electorate don't smoke.

I am sure you would concede the existence of many anectdotes of private insurance companies denying coverage for things that you and I would judge necessary. What is the recourse then?

Moving of the goal posts duly noted. Denying coverage is one thing, denying care is another matter entirely. By law hospitals are required to render care irrespective of ability to pay.

Maybe the good old marketplace will offer up another (better) insurance company that would be glad to pay for the expensive operation you need at the time of application!

Insurance doesn't work that you need an operation so you go sign up. No insurance company could ever be profitable.

If you do not have insurance it is not likely you can afford to have this procedure done in an ER, even if they would do it in that venue.

But they will do it, because that is the law.

As for having it done by doctor or hospital as an uninsured individual without guaranteed payment, good look getting that done. I am relatively certain that this is not a procedure that a hospital or doctor would be required to do for an indigent person. Correct me if I am wrong here.

Yes you are wrong. Going to the ER will get it done. You can get just about anything via the ER if you wait long enough and complain vociferously enough. This is one reason why health care in the U.S. is so expensive. To the extent that a government provided program reduces this kind of usage of ERs it will save money. But the increased demand due to increasing the number of people who have easier access to health care will raise costs.

If he will not, what does that say about his priorities?

What?!?!?! I'm shocked. You'd better be careful your good standing as a collectivist could be called into question here.